As immunotherapy moves earlier into cancer treatment pathways, its clinical benefits are increasingly well established. However, whether these benefits represent good value for money depends not only on drug price and health system context, but also on the cancer type in which immunotherapy is used.
A new systematic review published in JAMA Oncology examined 69 full economic evaluations of adjuvant immunotherapy across a wide range of tumour types, synthesising evidence on costs, quality-adjusted life-years, and incremental cost-effectiveness ratios.
CLINICAL SUMMARY
What was examined
A systematic review of published economic evaluations assessing the cost-effectiveness of adjuvant immunotherapy across multiple cancer types.
Key findings:
- Most studies reported gains in quality-adjusted life-years (QALYs) or life-years with adjuvant immunotherapy compared with standard care.
- Overall, 58% of evaluations concluded that adjuvant immunotherapy was cost-effective, but results varied substantially by cancer type and setting.
- Cost-effectiveness was most consistent in melanoma and non–small cell lung cancer, and far more variable in other tumour types.
Clinical implications:
- The economic value of adjuvant immunotherapy is highly indication-specific, not uniform across cancers.
- Tumour-specific evidence, local willingness-to-pay thresholds, and drug pricing should guide adoption.
- Policymakers and clinicians should avoid extrapolating cost-effectiveness from one cancer type to another.
The review included model-based economic evaluations published between 2015 and 2025 that assessed adjuvant immune checkpoint inhibitors or related strategies. Outcomes were reported primarily as cost per QALY gained or cost per life-year gained. Studies covered multiple cancers, including melanoma, non–small cell lung cancer (NSCLC), renal cell carcinoma, urothelial cancer, breast cancer, and others.
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While most studies showed improved health outcomes with adjuvant immunotherapy, economic value differed markedly between tumour types:
- Melanoma and NSCLC had the most consistent evidence supporting cost-effectiveness. These cancers have relatively mature survival data and large absolute benefits from adjuvant immunotherapy, which translates into more favourable cost-effectiveness ratios across multiple health systems.
- Renal cell carcinoma and urothelial cancer showed mixed results, with cost-effectiveness highly sensitive to model assumptions, treatment duration, and drug price.
- In other tumour types, including some breast and gastrointestinal cancers, results were more variable and frequently exceeded common willingness-to-pay thresholds, particularly when long treatment durations were assumed.
This heterogeneity reflected differences in baseline prognosis, magnitude of reduction in recurrence risk, and strength of clinical trial evidence across tumour types. Across all cancer types, cost-effectiveness was strongly influenced by:
- Drug acquisition cost
- Duration of treatment
- Survival modelling assumptions
- National willingness-to-pay thresholds
The review also noted that industry-funded studies were more likely to report favourable cost-effectiveness outcomes, reinforcing the need for cautious interpretation.
These findings highlight that adjuvant immunotherapy should not be viewed as a single economic proposition across oncology. A regimen that represents good value in melanoma or NSCLC may not do so in another cancer type with smaller absolute survival gains or higher uncertainty in long-term outcomes.
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For clinicians, this reinforces the importance of aligning treatment decisions with tumour-specific evidence. For policymakers and health technology assessment bodies, it supports indication-by-indication appraisal rather than broad class-based funding decisions.
Adjuvant immunotherapy can deliver meaningful health gains, but its cost-effectiveness is not uniform across cancers. Economic value depends heavily on tumour type, clinical benefit magnitude, and local pricing and thresholds. These results support a tailored approach to adoption, grounded in both clinical efficacy and cancer-specific economic evidence.
Paper: Mahumud RA, et al. Cost-Effectiveness of Adjuvant Immunotherapy in Cancer Treatments: A Systematic Review. JAMA Oncol. Published online January 22, 2026. doi:10.1001/jamaoncol.2025.6080 Access online here.